Constipation is defined as any two of the following features: straining, lumpy hard stools, a sensation of incomplete evacuation, use of digital maneuvers, a sensation of anorectal obstruction or blockage with 25 percent of bowel movements, and decrease in stool frequency (less than three bowel movements per week).

Increase fiber (20-25 grams per day), exercise and water in diet

Bulk-forming laxatives first line and osmotic laxatives can be used in patients not responding satisfactorily to bulking agents

Patients who are older than 50 with new onset constipation should be evaluated for colon cancer

Sudden onset abdominal pain occurring 10-30 minutes after eating in a patient (usually elderly) with a risk of emboli formation (on the exam it is usually atrial fibrillation or CHF). It is associated with bleeding per rectum with or without diarrhea. Physical examination findings are usually disproportionate with abdominal pain.